Long term survival of 115 patients with ischaemic heart disease and ventricular flutter induced by programmed ventricular stimulation in the absence of documented spontaneous sustained ventricular arrhythmia induced ventricular flutter after myocardial infarction

The clinical significance of rapid monomorphic ventricular tachycardia (VT) (> 270 beats/min), also called ventricular flutter, remains controversial in patients without documented spontaneous sustained VT. The aim of this st udy was to evaluate the outcome of 11S patients with ischaemic heart diseas e, aged 58 +/- 10 years, without spontaneous ventricular arrhythmias, but w ho had inducible ventricular flutter during programmed ventricular stimulat ion. The patients underwent stimulation to evaluate the prognosis after myo cardial infarction or to investigate a malaise with or without loss of cons ciousness. Sustained ventricular flutter was the only inducible arrhythmia in all patients. The mean left ventricular ejection fraction (LVEF) was 42 +/- 14%. During an average follow-up period of 66 +/- 43 months, 31 deaths, includin g 27 of cardiac causes, were observed. The 1, 5, and 11 year survival of th e whole population was 94, 79 and 64% respectively. In univariate analysis, anterior wall myocardial infarction, a low LVEF, th e presence of non-sustained ventricular tachycardia (NSVT) on 24 hour Holte r monitoring and Class III antiarrhythmic treatment, were poor prognostic f actors (p 0.05). In multivariate analysis, the only independent predictive factors of mortal ity were low LVEF (p= 0.006), the presence of NSVT on Holter monitoring (p= 0.003) and the absence of betablocker therapy (p= 0.015). Medical therapy with betablockers or the implantation of an automatic defib rillator may be indicated in these patients at higher risk.